Background
Engagement in services to support healthy weight management during pregnancy is poor. A better understanding of those who attend is important in supporting women to participate in preventative health services.

Aims
This retrospective observational study aimed to report attendance rates of pregnant women with obesity (body mass index (BMI) ≥ 30 kg/m2) referred to a dietitian between 2012 and 2018 for weight management and describe who was referred and attended.

Materials and Methods
Demographic, attendance and medical data for women with obesity who were either referred to a dietitian or were not referred were sourced from hospital data. Chi‐squared and t‐tests were used to compare groups. Binary logistic regression analysis was used to identify characteristics associated with attendance within the referred group.

Results
Of 5426 eligible women, 523 were referred to the dietitian, and 4903 women were not referred (Total sample: 29 ± 6 years, 39.0 ± 2.1 weeks gestation at birth). Referred women self‐reported a 6.7 kg/m2 higher pre‐pregnancy BMI, 7% more were subsequently diagnosed with gestational diabetes mellitus (GDM), and 9% more were induced (P < 0.001) indicating a higher risk of adverse outcomes. Referred women attended a median (range) of 2 (0–8) appointments. The majority (78%) attended ≥1 appointment, and 41% attended ≥3 appointments. Women referred by a midwife (65%) or diagnosed with GDM were 1.9 and 3.0 times more likely to attend, respectively (P < 0.01). Being a smoker was negatively associated with attendance (odds ratio 0.388, P < 0.001). Conclusions Pregnant women with obesity referred for dietetic weight management appear at higher risk of adverse outcomes, with most attending ≥1 appointment. Engaging midwives in promoting referrals may increase attendance.